Quality Improvement Initiatives for Outpatient Management of COVID-19 in Community Hospitals in Uganda (Preprint)

BACKGROUND The coronavirus disease (COVID-19) dramatically disrupted outpatient care delivery. Guidelines for HCPs and refresher courses have been developed to boost their skills and knowledge of the disease though not effectively disseminated through training due to physical distancing and unprecedented disruptions to traditional avenues for delivery of medical education leaving many HCPs with apparent lack of knowledge and skills hence an urgent need to fill knowledge and training gaps. OBJECTIVE Our goal was to improve COVID-19 outpatient management through use of a mobile-based decision support system (DDC19) in COVID-19 patient risk stratification in community hospitals in Uganda. METHODS The project was implemented in 139 community hospitals in Uganda, the patients were assessed for the risk of COVID-19 and stratified as either Low, Moderate or High risk using the adopted excel sheet based on the DDC19 principle to assist HCPs in real time data collection, dynamic risk assessment, triage management, and follow-ups of COVID-19. We ran an 8 months training using an International Virtual COVID-19 Critical Care Training Forum for Healthcare Workers and five-days QI trainings for hospital leaders using a QI training curriculum developed by USAID and Ministry of Health Uganda QI Frame Work and Strategic Plan (2021-2025). RESULTS A total of 319 patients were tested for COVID-19 and stratified as low risk 195(61.1%), moderate risk 102(32.0%) and high risk 22(6.9%), 21(6.6%), a total of 854 HCPs were trained their knowledge score improved from 42.69% to 72.70%, knowledge scores of 139 hospitals leaders in QI projects increased from 59.99% to 70.04%. CONCLUSIONS COVID-19 patient risk stratification was achieved, The knowledge and skills of HCPs in application of best practices for management of COVID-19 increased from 42.69% to 72.70%, The knowledge and skills of leaders in design and implementation of outpatient QI projects improved from 59.99% to 70.04%. The innovative nature of the project improved the COVID-19 patient risk stratification was achieved despite the non-approval of use of DDC19 in Africa and the improvement in the knowledge and skills of the HCPs and hospital leaders is key for improved diagnosis, risk stratification and outpatient management of COVID-19 patients